The Sneezin' Season

HEALTH

What You Need To Know To Be Well-armed In The Fight Against Colds And Flu

December 23, 1997|By Shari Roan, Los Angeles Times

Cold and flu season is here. Look around. Adults are coughing and sneezing and assuring you, ``Don't worry. I'm not contagious anymore.'' And the children, ah, the little darlings, obviously are confused: They think their clothing and the backs of their hands are interchangeable with Kleenex.

Here is some information to help with this seasonal battle.

* Fever. Perhaps no aspect of cold and flu season is more universally misunderstood than fever.

And it's not just consumers who are confused about the good, bad and ugly characteristics of fever. Even the top scientific brains around the world are, admits one researcher, ``beginning to realize everything we don't know about fever.''

One reason for the confusion dates back about 100 years when people suddenly began to view fever very differently. At that time, drugs to reduce fever were invented, and people began to fight fever instead of embracing it as a good thing, says Matthew J. Kluger, a scientist at the Lovelace Respiratory Research Institute in Albuquerque, N.M.

``For thousands of years, fever was considered a protective response, and fevers were induced by physicians to combat certain infections. But with the advent of antipyretic drugs medications that block fever), physicians started reducing fevers, and fever therapy was virtually abandoned,'' he says.

But, in recent years, Kluger says, ``the view of fever as a defense mechanism has re-emerged.''

In general, Americans have an unreasonable fear of fever, says Dr. Mark Stegelman, a pediatrician in Atlanta.

That fear causes many unnecessary visits to doctors' offices and emergency rooms each year - particularly when the patient is a child, according to the Association for the Care of Children's Health. One study found that fever was the principal complaint among as many as 30 percent of all patients seen by pediatricians.

But fever is rarely harmful, says Stegelman, a spokesman for a new Children's Health Association campaign to help parents understand fever in their children.

``Only extremely high fevers, of 108 degrees Fahrenheit or higher, have been known to cause brain damage. And those fevers are usually linked to specific illnesses,'' Stegelman says.

Only fevers of 105 degrees and higher need immediate attention, he says, mainly because they are a clue that a serious infection could be present. In addition, infants younger than 3 months with any fever should be checked out. A child with a high fever who may have a potentially serious illness also may have one or more of these symptoms: stiff neck, difficult to awaken, skin rash or seizure.

To offset the fear-of-fever mania in the United States, the association is promoting a new informational tool to help parents address fever in a rational way. The method is called CALM:

* Check your child's temperature.

* Assess other signs and symptoms your child may have.

* Lower the temperature of the environment to make your child more comfortable.

* Monitor your child's behavior and temperature.

For a free CALM brochure, call: 1-800-997-2256.

* Antibiotics. This winter, millions upon millions of prescriptions for antibiotics will be written for infectious illnesses. Most are silently accepted by the patient and faithfully filled.

But how often do you, as a consumer, question whether the antibiotic you're getting is the right one for you?

If you've never thought about that, you'd better start. Increasingly some of the most popular - and least expensive - antibiotics are losing their punch against an array of bacteria. And yet these very antibiotics may be the ones that your HMO demands be prescribed first, says Dr. Gideon Bosker, an expert on medications at the Oregon Health Sciences University.

Meanwhile, several newer, but expensive, antibiotics remain on the shelf.

According to Bosker, author of a new book, Pills That Work, Pills That Don't, (Harmony Books), Americans have done a great job of questioning their doctors about many aspects of health care and participating in decisions. But when it comes to prescription medications, most consumers are hands-off.

And, when it comes to the antibiotics typically prescribed for wintertime infectious illnesses - such as bronchitis, sinusitis, ear infections, strep throat and pneumonia - consumers should realize they may not be getting a ``neutral'' opinion on what will work best. This is because, under many managed-care plans doctors are guided on what to prescribe.

The goal is to keep costs down, Bosker says. ``These decisions go on behind what I call the drug secrecy barrier.`` The doctor has incentive to try the least expensive medication. But selecting cheaper medications ``is just like selecting cheaper technological products. You are downgrading consumers to medications that may not work as well.''